Audits and Coding Quality Reviews

The OIG and CMS recommend “regular” reviews, but give no guidance as to frequency. We suggest that our clients establish an annual budgetary amount, and then stagger it in quarterly reviews instead of one large annual evaluation. The cost is the same and has three major benefits. First, the expense of the audit is spread throughout the year. Second, the providers and coders receive feedback on the status of the coding throughout the year. Third, a program of regular quarterly feedback provides an opportunity to correct the errors identified and then confirm that the corrective action has been effective without having to wait an entire year. If coding errors continue to occur, then a targeted plan of action can be instituted.

The implementation and operation of this program is quite simple. Periodically (monthly, quarterly, semi-annually, or annually) participating practices send us a representative sample of their visit notes, procedure reports and claim forms. We perform a government-style audit of the coding, using all available screens and regulations. We then send you a case-by-case analysis of our findings. Our medical coding and surgical coding accuracy evaluations are designed to be part of a continuous quality improvement program. It gives our clients’ medical coders and surgical coders the feedback they need to more accurately code the patient-care services.

Have you been the target of a compliance audit? If you think you’re being treated unfairly, let us “audit the auditors.” Our findings can be your best defense!

Latest Blog Posts:

  • 1377492525

Hospital Agrees To Settle Over Billing Allegations

May 23rd, 2018|Comments Off on Hospital Agrees To Settle Over Billing Allegations

The US Attorney’s Office for the Middle District of Pennsylvania announced that Charles Cole Memorial Hospital agreed to pay the United States $373,547.54 to settle allegations that they failed to bill under a particular modifier […]

  • 1280x720_10830C00-SKHEO

Resident of Webster NY Sentenced for Fraud

May 21st, 2018|Comments Off on Resident of Webster NY Sentenced for Fraud

Judith Morale, formerly known as Judith Remo, of Webster NY, was sentenced to three years of probation for health care fraud, announced US Attorney Scott W. Murray.

Read the full story here!

  • elder-healthcare-fraud-730x350

Report from the Department of Justice Fraud & Abuse Control for 2017 sheds light upon the importance of compliance

May 18th, 2018|Comments Off on Report from the Department of Justice Fraud & Abuse Control for 2017 sheds light upon the importance of compliance

In April, the Government released last year’s accomplishments for their work in Healthcare Fraud and Abuse. In 2017 $2.6 billion was returned to the Federal Government or paid to private persons. Specifically; $1.4 billion was […]

  • 78hg2l6p2i0mm4zzmas8rx58dxkuy17

Northwestern, Centegra seek to finalize 10-hospital merger

May 16th, 2018|Comments Off on Northwestern, Centegra seek to finalize 10-hospital merger

Northwestern Memorial HealthCare and Crystal Lake (based out of Chicago) and Centegra Health System (Illinois based) could close their merger deal by Sept. 1, according to a recent filing with the Illinois Facilities & Services […]